Hm. Krumholz et al., Aspirin and angiotensin-converting enzyme inhibitors among elderly survivors of hospitalization for an acute myocardial infarction, ARCH IN MED, 161(4), 2001, pp. 538-544
Citations number
20
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background: Aspirin and angiotensin-converting enzyme (ACE) inhibitors are
recommended for secondary prevention after acute myocardial infarction (AMI
), but several studies have suggested that the combination of these medicat
ions may produce a negative interaction.
Objective: To evaluate the effect and interaction of aspirin and ACE inhibi
tors on mortality among elderly patients who survived a hospitalization for
AMI.
Methods: We evaluated the effect and interaction of aspirin and ACE inhibit
ors on mortality in patients aged 65 years and older who survived hospitali
zation with a confirmed AMI who were ideal candidates for the therapies.
Results: Among the 14129 patients, 26% received aspirin only, 20% received
ACE inhibitors only, 38% received both, and 16% received neither at dischar
ge. In the multivariate analysis, patients who received both aspirin and AC
E inhibitors alone had a significantly lower 1-year mortality (adjusted ris
k ratio [ARR], 0.86 [95% confidence interval (CI), 0.78-0.95] vs 0.85 [95%
CI, 0.77-0.93], respectively) compared with patients who received neither a
spirin nor ACE inhibitors at discharge. Prescribing both aspirin and ACE in
hibitors was associated with a slightly lower risk of mortality (ARR, 0.81;
95% CI, 0.74-0.88) than that seen in aspirin-only or ACE inhibitor-only gr
oups, but the difference was not significantly different from the use of ei
ther medication alone.
Conclusions: The benefit of ACE inhibitors and aspirin is consistent with w
hat would be expected from overall results of randomized trials; prescribed
together, the effect is slightly greater than with either one alone, but n
ot significantly or substantially so.